Anxiety disorders are the most common psychiatric illnesses in youth with prevalence rates averaging 5-20%. These disorders are associated with significant short- and long-term impairment in academic, familial, social, and psychological functioning. Although medication and cognitive-behavioral therapy (CBT) have been found to be effective in the short term, questions remain regarding the durability of treatment effects and the relative impact of intervention on long-term functioning. This competing continuation application (in response to PAR- 09-153) will continue the successful multi-site collaboration of the Child/Adolescent Anxiety Multi-modal Study (CAMS) group to conduct a 5-year follow-up of the sample of youth with anxiety disorders that participated in the CAMS trial. The six sites are: New York State Psychiatric Institute; Duke University Medical Center; Johns Hopkins University; Temple University; University of California at Los Angeles; and Western Psychiatric Institute and Clinic. The central questions of the proposed study, entitled the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), are to examine the long-term psychiatric, physical, and functional outcomes of youth with anxiety disorders who were randomized to one of four treatment conditions (i.e., CBT, sertraline [SRT], pill placebo, or combined CBT + SRT). CAMS succeeded in randomizing 488 children/adolescents. The CAMELS is critical in light of the need for additional information about the effects of successful treatment on the course of anxiety symptoms and their sequelae and the NIMH priority to understand the developmental trajectories of mental illness (US DHHS, 2008). CAMELS will enroll the largest sample of carefully characterized youth with anxiety disorders and will inform the field about: 1) the preventive effects of successful treatment (psychosocial; medication) on the development of later psychopathology, 2) treatment durability, 3) potential long-term adverse effects (e.g., from chronic use of medication), and 4) predictors of relapse or long-term maintenance. Findings will also be used to refine current treatments, shedding light on how existing interventions may need to be augmented or personalized to target specific distal psychopathology and/or functional outcomes for specific children. PUBLIC HEALTH RELEVANCE: This five-year study, entitled the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), proposes to follow up the sample of children and adolescents (N=488) with anxiety disorders that participated in the successful multi-site collaboration of the Child/Adolescent Anxiety Multi-modal Study (CAMS; U01MH64089). The central question of the proposed study is to examine the long-term psychiatric, physical, and functional outcomes of youth with anxiety disorders who were randomized to one of four treatment conditions (i.e., cognitive behavioral therapy (CBT), sertraline (SRT), pill placebo, or combined CBT + SRT. Key findings will inform the field about the preventive effects of successful treatment (both psychosocial and medication) on the development of later psychopathology and treatment durability.